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Related Experiment Videos

Posttraumatic diaphragmatic hernia and death--etiologic factor or putrefactive artifact?

R James1, J Gilbert, R W Byard

  • 1Forensic Science, Adelaide, SA, Australia.

The American Journal of Forensic Medicine and Pathology
|April 20, 1999
PubMed
Summary

Late-presenting diaphragmatic hernias can be fatal if undetected, potentially causing cardiorespiratory issues or organ damage. This case highlights the challenge in distinguishing antemortem diaphragmatic hernias from postmortem artifacts, especially in putrefied bodies.

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Area of Science:

  • Forensic Pathology
  • Gastroenterology
  • Cardiology

Background:

  • Late-presenting diaphragmatic hernias are often asymptomatic until severe complications arise.
  • These hernias can result from congenital defects or acquired trauma.

Observation:

  • A case of a 72-year-old male found deceased with a right-sided diaphragmatic hernia involving small intestine herniation into the pleural cavity is presented.
  • The patient had a history of a motor vehicle accident 8 years prior.
  • The deceased was in a putrefactive state, complicating the interpretation of the hernia.

Findings:

  • While postmortem herniation due to putrefaction is possible, tight twisting of the herniated small intestine around a pleural adhesion suggested an antemortem event.
  • Severe autolysis prevented definitive assessment of ischemic changes in the herniated intestine.

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Implications:

  • Diaphragmatic hernias can be a contributing factor to death across all age groups.
  • Distinguishing between antemortem diaphragmatic hernias and postmortem artifacts requires careful evaluation, especially in cases with significant putrefaction.